There is a lot of confusion about Medicare, DVA and ndis billing when it comes to Podiatry treatment. Below is a list of FAQ’s to help you understand the process and find out if you are eligible for Medicare or DVA rebates and how we can help you claim using your ndis funding.
Medicare Rebates
Q. Is there Medicare Rebates for Podiatry Services?
Yes! To qualify for 5 yearly Podiatry Medicare Rebates, your GP must place you on an Enhanced Primary Care Plan (EPC). Your GP must either diagnose a chronic condition or identify complex care needs.
Q. What is meant by chronic conditions or complex care needs?
Chronic conditions are defined as conditions that have been or are likely to be, present for six (6) months or more. Complex care needs mean, that in your GP’s opinion, you would benefit from the care provided by a range of health professionals who provide different types of services. Usually, it would involve 3 health care providers eg GP, Podiatrist & Physio Rehab. It can be any recognised allied health provider as long as they are registered with Medicare.
Q. How do I get an EPC plan?
Visit your GP and ask them to prepare an EPC plan, which means they must lodge 721 & 723 Medicare forms with Medicare. Depending on how and when your GP lodges these forms, it can take a number of days or weeks. Electronic lodgement is always faster! Ask your GP when they are likely to complete this process and also ask if you are eligible for the maximum of five (5) visits per calendar year.
Q. Can I use my private health insurance cover in conjunction with EPC?
You need to decide if you are going to use your Medicare rebate or your private health insurance, as you can NOT claim from both for the same consultation. Once you have claimed all your Medicare rebates you can then claim additional consultations via your private health insurance.
Q. Once I’m on an EPC plan, how does the billing process work at Brunswick Health?
To be able to receive the 5 rebates from Medicare, your GP must provide you with a form called “Enhanced Primary Care (EPC) Program Referral form for individual Health Services under Medicare”. Check your GP has filled in the number of Podiatry services he or she wishes you to undertake, for example, “5 Podiatrist (10962)”. This means you are entitled to a maximum of 5 rebates for Podiatry services for the year. Should your GP write 2, then you will only be entitled to 2, so best to discuss your needs carefully with your GP before any forms are submitted to Medicare.
Q. If I have an EPC plan, do I still have to pay on the day when I see a Podiatrist at Brunswick Health?
Yes, you pay the full podiatry consultation fee on the day but we will lodge your claim on your behalf electronically so you can receive the rebate directly from medicare. The medicare rebate (at the time of writing this article) is $54.60 per visit.
Q. What if I need treatment before I see my GP or before my EPC Plan is approved by Medicare?
Unfortunately, Medicare will not rebate any visits PRIOR to the date your GP wrote on the EPC forms. This means you must see your GP FIRST if you want to receive any rebates for your Podiatry visits. You can still attend for treatment but you will not receive any Medicare rebates unless you are able to claim via your private health insurance that covers Podiatry services. At the clinic, we do offer on the spot private health claiming via HICAPS facility so need only pay the gap.
Q. What if Medicare does not pay for my visits?
Your GP is the primary referrer for this service and it is usually due to:
- an error with the forms the GP has lodged or
- you have exceeded your maximum of 5 visits per calendar year.
Should Medicare refuse to pay any rebates for your Podiatry consultation(s) you need to speak to your GP because EPC forms can only be lodged by GP’s.
Q. I have already used my 5 EPC entitlements this year can I have more?
Currently, you are only eligible for a maximum of 5 EPC rebates each calendar year in total, hence you will need to wait until January the following year to reapply for a further 5 EPC visits with your GP. Your entitlements solely depend on what your GP submits to Medicare.
Q. If I don’t use my 5 EPC visits in one year can these roll onto the next year?
No, if you don’t use your 5 visits each year, you forfeit them.
Q. If I don’t use my 5 EPC visits can my wife, husband or child use them?
No, the rebate is only for you. Should a family member require Podiatry consultations, they must visit their GP and ask if they qualify for the EPC program. It is illegal for one person to receive treatment and for another person to claim for that same treatment.
Q. I’m not sure if I have used my EPC entitlements this year?
If you have been referred by your GP to see another Health Professional such as a Chiropractor or Physiotherapist in the same year, chances are, you have used part or all of your EPC entitlements as the maximum is 5 per year for all services. To check, log into your myGov app using your smartphone or call Medicare on 132 150 direct. Alternately you can check with your GP as to what you are currently entitled to. Due to privacy issues, Medicare will not release your information to a third party such as our reception staff.
Q. Am I always entitled to 5 EPC visits?
Your GP has the final say as to what and how many medicare EPC rebates you are entitled to. The maximum each year under the EPC scheme is 5 visits in total (not 5 each profession).
Q. Does EPC cover for any X-Rays?
No, but the majority of X-rays are bulked billed at a local radiological centre when referred by our Podiatrist at Brunswick Health. This excludes CT Scans or MRI.
DVA Bulk Billing
All Veterans Affairs (DVA) consultations are bulk billed at Brunswick Health providing your GP has submitted the paperwork to DVA and it has been approved. The amount of treatment you are entitled to will depend on what you have. You are generally not restricted to 5 visits/year such as the Medicare EPC Scheme.
Your DVA bulk-billing entitlements depend on the type of DVA card issued:
- If you are a GOLD cardholder you are entitled to be treated for any condition.
- If you are a WHITE cardholder you are entitled to be treated for only the conditions specified by DVA. This means to see a Podiatrist, lower leg or foot must be the area DVA has specified otherwise we cannot bulk bill Podiatry services as DVA will not pay.
Should DVA refuse to pay for Podiatry consultations because your claim is finished or incomplete then you are required to pay your account within 14 days otherwise further administration fees will apply.
National Disability Insurance Scheme (ndis)
There are essentially 3 ways you can use ndis funding once you qualify for the national disability scheme.
Option 1: Self Managed Funds ~ This is when ndis provides a certain amount of funding directly to the person to use for any health services they wish to attend. This means the person receiving treatment directly pays on the day of treatment.
Option 2: Plan Managed Funds ~ This is when an ndis financial intermediator company directly reimburses health practitioners. This means the company that manages the person’s ndis funds pay on behalf of the person receiving treatment. Usually, an account is sent to the company requesting payment for health services rendered.
Option 3: Agency Managed Funds ~ This is when an ndis registered health provider deals directly with the government’s ndis department. The registration and payment process is long and convoluted, hence many health practitioners opt not to pursue ndis provider registration.
At Brunswick Health we can only participate if the ndis eligible individual is either plan-managed or self-managed (Options 1 or 2). If you are not sure best to contact your ndis Local Area Coordinator (LAC) and ask for a review of your plan and further information.